Individual
STEVEN ERIC VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
10415 WALLACE ALLEY ST, KINGSPORT, TN 37663-3936
(423) 390-0451
Mailing address
10415 WALLACE ALLEY ST, KINGSPORT, TN 37663-3936
(423) 390-0451
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
215987
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
29061
TN
Other
Enumeration date
12/04/2020
Last updated
11/09/2023
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